Childhood epilepsy linked to significantly lower long-term educational attainment

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Childhood epilepsy is linked to significantly poorer exam grades and long-term educational attainment, with the lowest levels of academic achievement among those whose neurological disorder started when they were very young, finds a large, long-term Danish study published online in the Journal of Neurology Neurosurgery & Psychiatry.

While it's not clear whether the condition directly impairs brain function to the extent that it compromises educational achievement, the mechanisms are likely multifactorial and cumulative, warranting proactive assessment and support for those affected, suggests a linked editorial commentary. Up to 1% of children in high-income countries have epilepsy, which may be accompanied by neurodevelopmental disorders, such as autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), cerebral palsy and intellectual disability, note the researchers. These children may also find it difficult to focus and concentrate, they add.

Despite the fact that epilepsy is among the most common neurological disorders of childhood, only a few large-scale studies on long-term educational outcomes have been published.

To build on the evidence base, the researchers measured educational achievement among Danes whose epilepsy was diagnosed in childhood, tracking their academic performance from adolescence up to age 35 and focusing in particular on the potential influence of epilepsy subtypes and coexisting psychiatric issues. They included all 1,195,138 children (just over 51% of them boys) born in Denmark between Jan. 1, 1987, and Dec. 31, 2005, whose educational attainment was tracked up to the end of 2023.

They retrieved relevant information on diagnoses of epilepsy and other psychiatric and neurological conditions before age 15, and on academic performance from primary school onward, from national registry data linked to personal identification numbers. Of the total, 11,758 (1%) were diagnosed with epilepsy at an average age of 7. Information on final exam grades for first-level schooling (up to ages 15–17) was available for 1,092,980 children (91.5%; just under 0.7% had epilepsy) for math and for 1,083,374 children (91%; 0.7% had epilepsy) for languages.

Children with epilepsy tended to have more pregnancy complications, including low birth weight, Apgar scores (a basic newborn health check) and gestational age at birth, as well as younger parents with lower levels of education and income.

Of these children, 1,400 (12%) didn't complete their first-level schooling, compared with 45,451 (4%) of the 1,183,380 children without epilepsy.

After adjusting for potentially influential factors, epilepsy was associated with a threefold higher likelihood of not completing first-level schooling by age 17. And there were gender differences: Among girls, the odds were nearly four times greater; among boys, they were 2.5 times greater, despite the fact that early-onset and/or complicated epilepsy was more common in boys than in girls. Children with complicated epilepsy or whose condition had started in very early childhood had four times greater odds of not completing first-level schooling than those with uncomplicated epilepsy.

Similarly, those with coexisting psychiatric conditions, intellectual disability or autism spectrum disorder were significantly less likely to complete this level of education. Final exam grades in math and languages were also lower among children with epilepsy than among children without the condition, a legacy that continued across the spectrum of educational attainment. For example, among 30-year-olds, just over a third (37%) of those with childhood epilepsy hadn't extended their education beyond first-level schooling. This compares with 15% of those without the condition. And among 35-year-olds, around 1 in 10 (nearly 9.5%) of the epilepsy group had gone on to the highest level of education, compared with 1 in 5 (19.5%) of the comparison group.

Children with early-onset or complicated epilepsy were especially likely to be educationally disadvantaged, as were those with generalized rather than focal epilepsy (affecting one particular area of the brain), particularly for higher education. Worryingly, the risk of death was substantially higher among those with epilepsy: 6% of those with childhood epilepsy died before age 35, compared with less than 1% of those without the condition.

This is an observational study, so no firm conclusions can be drawn about cause and effect.

The researchers also highlight various limitations to their findings, chief among them the lack of information on seizure frequency and control and the use of antiseizure medication—factors that may influence academic performance. Nevertheless, they conclude: "Our findings underscore the need for assessment of academic capacity as well as targeted intervention, integrating educational and psychosocial support to optimize the educational potential for young people with childhood-onset epilepsy."

In a linked editorial commentary, Dr. Sallie Baxendale of UCL Queen Square Institute of Neurology in London emphasizes that the study doesn't prove that childhood epilepsy impairs cognitive development. "Rather, it demonstrates that children with epilepsy follow different educational trajectories. This distinction matters," she says. "Educational achievement is not a direct measure of brain function. It is a proxy measure, an outcome dependent to some extent on cognitive ability, but also shaped by school attendance, teacher and family expectations, psychiatric comorbidity, stigma and social exclusion, treatment burden, and the practical disruptions associated with managing a chronic neurological condition," she writes.

She concludes: "The most useful implication of this study is not determinism but intervention: better recognition of educational risk; proactive school liaison; monitoring of attendance; psychological support; anti-stigma work; and timely neuropsychological assessment. The findings should prompt us to ask not only what epilepsy may do to the developing brain, but also what living with epilepsy does to a child's opportunities to learn.”

Source: https://medicalxpress.com/news/2026-08-childhood-epilepsy-linked-significantly-term.html